Enhancing and Improving Treatment Engagement with Hispanic Patients

Abstract

The integrated care model promises to reduce the large health disparities experienced by many minority groups in the United States, including Hispanics. Integrated care operates from a public health perspective, meaning the emphasis of interventions is on their impact rather than efficacy. The impact of an intervention is a function of the efficacy of the intervention and the rate of participation, or percentage of the population that is able to access the intervention. Research showing that Hispanics are less likely to seek services for mental health problems and more likely to terminate therapy prematurely than members of other ethnic groups highlights existing challenges to the engagement of Hispanic patients in traditional mental health care (e.g., Alegria et al., 2008; Olfson et al., 2009). For example, in a study conducted by Alegria and colleagues (2008), 63.7 % of Latinos who met diagnostic criteria for a depressive disorder in the past year did not seek any mental health treatment, as compared to non-Latino white participants with a depressive disorder in the past year, of whom only 40.2% failed to seek treatment. Using data from the National Comorbidity Study Replication, Olfson et al. (2009) found that Latinos were three times more likely to prematurely terminate therapy than non-Latinos. Both internal and external factors limit engagement. Internal factors include attitudes and beliefs patients may have about behavioral health services and help-seeking. They may also include problem recognition and health literacy. Many of these internal barriers are influenced by culture. External factors include limited availability of Spanish speaking providers or lack of culturally congruent care centers, cost and insurance barriers, and the structure of health services in the United States. These challenges are reviewed more fully below. For the purposes of this chapter, we refer to research regarding the Hispanic population overall, as there is limited relevant research comparing these factors among Hispanic subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved)